Name of the Procedure:

Replacement, complete, of a non-tunneled centrally inserted central venous catheter (CVC), without subcutaneous port or pump, through same venous access.

Summary

This procedure involves removing an existing non-tunneled central venous catheter (CVC) and replacing it with a new one using the same venous access point. This type of CVC does not have a tunnel under the skin or a subcutaneous port or pump.

Purpose

The purpose of this procedure is to maintain venous access for patients requiring long-term intravenous medications, nutrition, chemotherapy, or blood draws. It addresses issues such as catheter infection, blockage, or displacement.

Indications

• Infection of the existing CVC.
• Mechanical issues such as blockage, kinking, or displacement of the CVC.
• Routine scheduled replacement to prevent complications.
• Persistent or frequent issues with the current CVC.

Preparation

• Patients may need to fast for a few hours before the procedure, especially if sedation or anesthesia is required.
• Adjustments to medications (such as blood thinners) might be necessary.
• Diagnostic tests such as blood work or imaging studies to assess the current catheter position and patient's overall health.

Procedure Description

1. The patient is positioned comfortably on an examination table.
2. The area around the existing CVC site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. The existing CVC is carefully removed.
5. A guidewire is inserted through the same venous access point.
6. Over the guidewire, the new CVC is threaded and placed into the correct position.
7. The guidewire is removed, and the new CVC is secured.
8. The new catheter site is cleaned, and a sterile dressing is applied.
9. The catheter is tested to ensure proper blood flow and function.

Duration

The procedure typically takes about 30 minutes to an hour, depending on complexity and patient-specific factors.

Setting

The procedure is usually performed in a hospital or an outpatient clinic setting.

Personnel

• Interventional radiologist or a specially trained healthcare provider
• Nursing staff
• Possible involvement of an anesthesiologist if sedation is used

Risks and Complications

• Infection at the catheter site
• Bleeding or hematoma formation
• Air embolism
• Thrombosis (blood clot formation)
• Catheter misplacement
• Potential for nerve damage

Benefits

• Continual medication and treatment administration via a central line.
• Reduction in the need for repeated venous sticks.
• Immediate access to the central venous system for medication, nutrition, or blood draws.

Recovery

• Post-procedure monitoring for a few hours to ensure there are no immediate complications.
• Instructions to keep the catheter site clean and dry.
• Guidelines on how to care for the central line at home.
• Follow-up appointments to monitor for complications and ensure the catheter is functioning correctly.
• Most patients can resume normal activities within a day with some limitations on strenuous activities.

Alternatives

• Peripheral intravenous (IV) access - suitable for short-term use.
• Other types of central venous catheters, such as tunneled CVCs or those with subcutaneous ports.
• Pros of alternatives can include longer duration between replacements or reduced infection rates; cons may include more complex insertion procedures or less convenience for certain treatments.

Patient Experience

• During the procedure: Patients may feel pressure or slight discomfort when the existing catheter is removed and the new one is inserted.
• After the procedure: Patients might experience some soreness or bruising at the insertion site.
• Pain management: Local anesthesia minimizes pain during the procedure; post-procedure pain can typically be managed with over-the-counter analgesics.
• Detailed instructions will be provided to ensure the patient's comfort and optimal recovery.